Car Racing Certificate - PDF

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Car Racing Certificate - PDF Powered By Docstoc
					MVR-27SC (4/10)
                                                North Carolina Division of Motor Vehicles
                                                        3155 Mail Service Center
                                                        Raleigh, NC 27699-3155



   APPLICATION FOR A                       STOCK CAR RACING THEME                                                   LICENSE PLATE

      
     Regular Stock Car Racing Theme $30.00                                  
                                                                             Personalized Stock Car Racing Theme $60.00


    I would like to make application for the following license plate.
    When applying for a personalized Stock Car Racing Theme license plate, please remember the suffix representing the driver
    will be the last letters on the plate. Personalized special plate choice must contain at least one alpha character. Please note
    the suffix that follows the driver’s name.
                          You are allowed four (4) spaces for a personalized message. ___ ___ ___ ___

     A.J. Allmendinger (AJ)                            Gordon (JG)
                                                         Jeff                                                NASCAR (NR)
    Greg Biffle (GB)                                  Denny Hamlin (DH)                                    NASCAR Hall of Fame (HF)
     Clint Bowyer (CB)                                 Kevin Harvick (KH)                                   Ryan Newman (RN)
     Jeff Burton (JB)                                  Jimmie Johnson (JJ)                                  Danica Patrick (DP)
     Kurt Busch (KB)                                   Kasey Kahne (KK)                                     Richard Petty Historic (RP)
     Kyle Busch (BH)                                   Matt Kenseth (NK)                                    David Ragan (DR)
     Dale Earnhardt (DE)                               Joe Logano (JL)                                      Elliot Sadler (ET)
     Dale Earnhardt Jr (JR)                            Mark Martin (NM)                                     Tony Stewart (TS)
     Carl Edwards (CE)                                 Juan Pablo Montoya (PM)



      The $30.00/$60.00 special fee is an (ANNUAL) fee due in addition to the regular license fee.
     z
                 Home                              NAME (To agree with certificate of title)

                                                             FIRST                          MIDDLE                            LAST

         AREA CODE–TELEPHONE NUMBER

                                                                                            ADDRESS


                 Office
                                                             CITY                           STATE                             ZIP CODE

                                                     Current North Carolina
         AREA CODE–TELEPHONE NUMBER
                                                          PLATE NUMBER                         VEHICLE IDENTIFICATION NUMBER



                                                          DRIVER LICENSE #           YEAR           MODEL            MAKE           BODY STYLE




                                            Owner's Certification of Liability Insurance

       I CERTIFY FOR THE MOTOR VEHICLE DESCRIBED ABOVE THAT I HAVE FINANCIAL RESPONSIBILITY AS REQUIRED BY LAW.


                              PRINT OR TYPE FULL NAME OF INSURANCE COMPANY AUTHORIZED IN N.C. – NOT AGENCY OR GROUP




                                       POLICY NUMBER – IF POLICY NOT ISSUED, NAME OF AGENCY BINDING COVERAGE




                  SIGNATURE OF OWNER                                                                        DATE OF CERTIFICATION

				
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Description: Car Racing Certificate document sample